Fischbach Peter
Children's Pediatric Cardiology Fellowship Program,Sibley Heart Center Cardiology and Emory University,Atlanta,Georgia,United States of America.
Cardiol Young. 2017 Jan;27(S1):S75-S79. doi: 10.1017/S1047951116002274.
The recreational use of illicit drugs remains an enormous and growing problem throughout the United States of America and around the world. Cocaine is most frequently thought of when considering the cardiovascular toxicity of illicit drugs. The association of cocaine use with sudden death due to myocardial ischaemia and infarction is well recognised, and this risk appears to be amplified by concomitant cigarette smoking and alcohol consumption. Like cocaine, amphetamine and its derivatives lead to indirect stimulation of the autonomic nervous system through the release of norepinephrine, dopamine, and serotonin in nerve terminals of the central and autonomic nervous systems. However, amphetamine lacks the ion channel-blocking properties of cocaine. Also similar to cocaine, coronary artery spasm may be induced in individuals with or without atherosclerotic disease and may lead to myocardial infarction. With the movement across the United States of America to legalise marijuana, or cannabis, for medicinal and recreational purposes, it is important to consider its potential deleterious effects. Marijuana has long been thought to have very few adverse effects with the exception of long-term dependence. There are, however, scattered reports of acute adverse events up to and including sudden death. These appear to be due to myocardial infarction. In conclusion, the incidence of sudden death associated with the use of these drugs varies from rare in the case of marijuana use to not infrequent with some drugs such as cocaine. It is important for care providers to recognise the potential for drug abuse when caring for a sudden cardiac arrest survivor.
在美国乃至全世界，非法药物的 recreational 使用仍然是一个巨大且不断增长的问题。在考虑非法药物的心血管毒性时，人们最常想到可卡因。可卡因使用与心肌缺血和梗死导致的猝死之间的关联已得到充分认识，而且这种风险似乎因同时吸烟和饮酒而加剧。与可卡因一样，苯丙胺及其衍生物通过在中枢和自主神经系统的神经末梢释放去甲肾上腺素、多巴胺和血清素，间接刺激自主神经系统。然而，苯丙胺缺乏可卡因的离子通道阻断特性。同样与可卡因相似，无论有无动脉粥样硬化疾病，个体都可能诱发冠状动脉痉挛，并可能导致心肌梗死。随着美国各地将大麻用于医疗和 recreational 目的合法化，考虑其潜在的有害影响很重要。长期以来，人们一直认为大麻除了会导致长期依赖外，几乎没有其他不良影响。然而，有零星报道称存在急性不良事件，甚至包括猝死。这些似乎是由心肌梗死引起的。总之，与使用这些药物相关的猝死发生率各不相同，从大麻使用时罕见，到某些药物（如可卡因）时并不罕见。对于护理人员来说，在照顾心脏骤停幸存者时认识到药物滥用的可能性很重要。
